=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003563446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ELIZABETH PEKURI DNP, CNP, APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2022
-----------------------------------------------------
Last Update Date | 08/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 HUNDERTMARK RD STE 205N
-----------------------------------------------------
City | CHASKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55318-1586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-903-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 ZANE AVE N
-----------------------------------------------------
City | BROOKLYN PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55443-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 637-762-8800
-----------------------------------------------------
Fax | 763-315-4669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | R202377-1
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 9442
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------